Welcome

Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and
others concerned about HIV/AIDS. Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the
conversation yourself by registering on the left side of this page.

Privacy Warning: Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive
and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a
username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own
physician.

All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators
of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please
provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are
true and correct to their knowledge.

Drawn while I had a cold sore and a gum infection was up. Still a viral load jump of 291 to 26,000 is pretty scary. Doc took more blood today to see what it is like now (2 weeks later), so here's hoping my body is kick ass and drops it super low again.

Good news is cd4 up at 791 and liver function back to normal after slight concerns last time.

Still, can't help but see the viral load being high (for me). It makes me more worried about passing it on and raises questions about TAP. Thoughts? Kind words? Unkind words?

Your viral load is actually low. The change isn't really all that clinically significant. If it were as big a problem as you feel it is, you wouldn't have had a rise in your CD4 count. That's a very respectable CD4, by the way.

Regarding your viral load making you more infectious, condoms will still protect your partner(s) regardless of how high or low your viral load may be. Using TAP on its own to protect your hiv negative partner isn't really a good idea unless you're in a stable, monogamous relationship where you know that neither of you have any other active STIs.

Keep in mind what I tell people over in the Am I Infected? forum - use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection - and in your case, their use will enable you to avoid transmitting your virus to others. It really is that simple!

Make sure you read through the condom and lube links in my signature line so you can use them correctly and with confidence. A correctly used condom rarely breaks, so knowing how to prevent breakage is something you need to have in your arsenal of living well with hiv.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

I don't really agree that it's not significant. I don't think it's dire at all, but its a significant change from where you were. 26000 is a moderate viral load. You went from low to moderate. If you go above 100,000 I would classify that as high.

I also don't agree with your relating the change to a cold sore. If something so minor as a cold sore can cause a 100 times change in viral load then imagine what a hard hitting flu or other infection would do. I don't think the cold sore has an iota of relevance.

Your not in the US I take it (they are putting everyone on meds here lately regardless of numbers) so what are your considerations? If it drops back down are you going to remain off meds and if it stays the same are not? What are your choices? You didn't say in your post if this is a decision point for you or your doctor.

I had a gum infection that put me in the hospital in the mid 90's. I felt like I was going to die. It was probably much worse than his though..

Was it the gum infection that put you in the hospital or was it that HIV had damaged your immune system to the point that a gum infection was able to put you in the hospital?

Maybe I am misunderstanding what a gum infection is. Seems like a generic term for gingivitis (or am I completely off base?)

I think my point is if a gum infection is causing you to go in the hospital (or your viral load to spike 100x its baseline) then there is some underlying damage done to your immune system. That should be addressed so something so minor isn't causing problems.

Was it the gum infection that put you in the hospital or was it that HIV had damaged your immune system to the point that a gum infection was able to put you in the hospital?

Maybe I am misunderstanding what a gum infection is. Seems like a generic term for gingivitis (or am I completely off base?)

I think my point is if a gum infection is causing you to go in the hospital (or your viral load to spike 100x its baseline) then there is some underlying damage done to your immune system. That should be addressed so something so minor isn't causing problems.

No, I was infected in April of 2005.

While gum infections can include something minor along the lines of gingivitis, my case was a deep infection in the gum that became absessed after I had a tooth removed.

With a vL of 26,000 over the course of 4 months at most (his last bloodwork done in March), I wouldn't be to keen on taking drastic measures just yet. The same vL over a year period or more, would be a much different story.

In any event, I'm glad his doctor ordered another set of labs to monitor this further.

I would say that it statistically significant, as would docs I think. My previous readings were all around the same, any difference in them is of no real significance.

The gum problem is a recurrent root issue causing an abscess on the side of my gum. It was causing me issues around that time. It was nothing to put me in hospital though! Then the cold sore. Both of these were going on because I was run down and not feeling great, suffering from lack of sleep also. I know I'm kind of grasping at straws and more likely my body is not as good at fighting the virus as I hoped.

Ann, I know all about condoms, I've used them literally every time I've ever had sex in my life. I am in a stable long term relationship, I think we would both be much more relaxed if my load was lower. We've talked about me going on TAP for him, and it also would put my mind at rest regarding the amount of virus raging in my system doing its devilish work.

The doc is good, I've asked to see him again. He gave us some great advice on other things too.

hi, maybe best to keep an eye on your CD4% for a better gauge of your immune system over time .....as you know CD4 counts jump all over the place even during the course of the day. Hope that your CD4% is stabilising and not in further decline. A few more tests over the coming year will better inform you.

I think I recall you are based in Canada.....I thought Canada would be now recommending all pozzies to start meds regardless of CD4 counts? If not perhaps it is just a matter of time......countries with socialised medicine (ie majority of the developed world) can be a bit more complicated.

I'm in the UK, so more complicated (but completely free and without any insurance stress - I'm happy I'm here). I am we'll aware that many countries are recommending meds for everyone and that there could well be benefits to doing so. That's not normally available here but I could sneak in the back door by using TAP as a reason. But at the same time I was weighing up whether it was the right thing to start meds when I seemed to have a natural resistance to the virus.

I'm not rushing into anything. i have these results on their way and another set in November.

Sounds good. But dont get a false sense of security that just because ur CD4 counts are stable does not mean that there is not a lot of nasty other crap things doing real damage in other parts of your body.....doctor's labs just test just the tip of the iceberg.

No meds mean replication is seeding your reservoirs which is of course is not good. What about potential uncontrolled replication in you CSF (brain etc), and in other organs and tissues that you do not get tested for HIV replication in your normal labs.....also inflammation on your organs causing damage despite your current low to moderate viral load and stable CD4 counts.

Perhaps do more research?.......the majority of latest info points to starting meds immediately and saving your body from damage in the future and for it to be in the best condition to take advantage of a cure when it arrives.

Ann, I know all about condoms, I've used them literally every time I've ever had sex in my life. I am in a stable long term relationship, I think we would both be much more relaxed if my load was lower. We've talked about me going on TAP for him, and it also would put my mind at rest regarding the amount of virus raging in my system doing its devilish work.

The doc is good, I've asked to see him again. He gave us some great advice on other things too.

I alluded to that in this post, I'm well aware at what happens in the body when the virus is left unchecked. Ive done A LOT of research. I was kinda happy for that to go ahead when my count was 291 but not so much at 26,000.

I'm erring towards treatment if it seems to be that I've now got a viral load in the tens of thousands.

I'm also in the UK and they generally won't allow treatment until your CD4s are consistently under 500 - more specifically in the 300s. Regardless of your VL unless it's consistently very high. Yours isn't high.

I went without treatment until last year, but I had to insist and it took a few years to finally convince them that I needed treatment. My counts were generally in the 400s, with increasingly frequent drops into the 300s and the occasional foray into the 500s.

I "looked good on paper". I was told I was stable and that treatment wasn't indicated, but what didn't show on my labs was the fact that I was increasingly feeling sick and tired - and sick and tired of feeling sick and tired.

I was quite happy for years to not be treated, until I started feeling like crap more often than not. I was diagnosed in February 2001, but with hindsight, I know for certain I acquired my virus in the spring of 1997. That means I went without treatment for fifteen years. I feel I should have started in 2009, rather than 2012.

So, what I'm trying to say to you is this: Listen to your body. You know your own body like nobody else can and no lab results can show. Everyone - poz or neg - has bad spells, but when bad spells become the norm and good days become fewer and farther between, take notice.

You may have success in arguing the TAP angle, but if your recent higher VL turns out to be a blip and subsequent VLs are low again, they might not consider TAP to be a strong enough argument. I didn't really have TAP as an argument, because my partner is also poz and they know it - we go to the same clinic.

If you do decide to argue for treatment, I suggest you go in fully armed, meaning that you know what combo you want and are able to tell them why you want that particular combo. If you use TAP in your argument, make sure you can display a good knowledge of how and why it works, and don't imply that you want TAP so you can bareback. Knowledge is power.

Good luck with whatever you decide. With your numbers waiting a while shouldn't be that big an issue, provided you feel physically well. Going on treatment requires dedicated commitment.

FYI - here's my labs from 2007 onwards, in case you're interested. My VL is listed as 00,000 for 2010-02-09 only because it wasn't done and I used those numbers to keep the formatting tidy.

I threw a strop for seven months because I couldn't be bothered going all the way to Liverpool only for them to tell me that I was stable and didn't need meds. Not a recommended way to go about things, but I was fed up with them not listening to my concerns and my wish to start treatment. Surprisingly, it actually had the effect of them finally listening to me and taking my concerns seriously. When I was asked why I hadn't been for an appointment for so long, I said, "why the fuck should I bother when all you do is pat me on the head and send me on my way?" Yep, I said exactly that. Sometimes the use of the eff-word is entirely appropriate.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Thanks Ann, it's really interesting to get a break down of your numbers over time like that. And thanks for the insight as well. The advice about being prepared is bang on I reckon.

On the note of tiredness, the few runs I've been recently have been awful, my legs are fatigued even before I start. Your words made me think my VL jump could be connected to it... Only time will tell, every test seems to ask more questions than it answers.

So I got my viral load results back today. 3704. Not bad, in two weeks I got rid of 23,000! I'm fully expecting it to be as low if not power next time in November. The only thing which was different between the two last tests was me being run down and with an active cold sore, I guess I just have to look after myself and keep healthy.

I don't really agree that it's not significant. I don't think it's dire at all, but its a significant change from where you were. 26000 is a moderate viral load. You went from low to moderate. If you go above 100,000 I would classify that as high.

I also don't agree with your relating the change to a cold sore. If something so minor as a cold sore can cause a 100 times change in viral load then imagine what a hard hitting flu or other infection would do. I don't think the cold sore has an iota of relevance.

This has been running through my mind. I just got my worst labs ever, except for when I was sick in the hospital. When I did the bloodwork, I knew it would probably be off. I was having that crappy feeling I get, when I am having a lot of anxiety. My labs have been pretty much status quo-- CD4 600-700, vl often under 20k (never higher than 30k and has been down to 9k), and percentage usually at 25%. Mine was low 400's this time, and my vl spiked to 50k. Percentage was the same at 25%. I noticed my normal 1,800 CD8 was down to 900.

So, we did more labs, which I have not gotten yet. Discussed meds. I have been thinking if anxiety can cause this result, then what would the flu do? If my numbers are fluctuating that much every month, what does that mean, in terms of health. I mean, I would normally do my labs, when I feel good. So, I get the results in the times I feel good. But, a good week each month, I have that high anxiety feeling, which makes me feel crappy. So, that makes me wonder whether certain times of the month, my numbers dip and my vl goes up. It does leave me wondering whether my status quo is really all that status quo. Or, whether fluctuations would be expected for someone not on meds.

Didn't mean to hijack the thread, but since there is a discussion going.... On the other hand, I may have to make a med decision soon, if these labs are the same or worse. This could be something real and not just an off lab, due to anxiety.

Hmmm whether the status quo perceived is truly the status quo? That's a good point. If I always look after myself before my labs and get a good result then this isn't a true reflection of my infection. At other times in those three months I could have a very different picture if I've gone out (my going out lasts for a few days sometimes) and come down with cold sores, colds, flu etc. that's something to bear in mind when thinking about treatment, which I'm erring away from at the moment as I've usually got a low viral load and great CD4.

I was on daily acyclovir for quite some time before I went on (hiv) meds and it was fantastic not having to worry about getting an outbreak every time I was run down, sick with a cold, or just plain stressed-out. It meant my body had one less virus to actively deal with.

Prophylactic acyclovir shouldn't break the bank - it's widely available as an affordable generic. You may have to specifically request your doctor prescribes a generic version though.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

I have and will be taking this up with my doctor next time I see him. It could have a dramatic effect on my long yet health if a single outbreak can cause such a viral spike. I have read a few articles about acyclovir resistant hsv which doesn't sound like fun, this seems to be more common in HIV positive people on long term prophylactic treatment. It seems everything has a downside...

This has been running through my mind. I just got my worst labs ever, except for when I was sick in the hospital. When I did the bloodwork, I knew it would probably be off. I was having that crappy feeling I get, when I am having a lot of anxiety. My labs have been pretty much status quo-- CD4 600-700, vl often under 20k (never higher than 30k and has been down to 9k), and percentage usually at 25%. Mine was low 400's this time, and my vl spiked to 50k. Percentage was the same at 25%. I noticed my normal 1,800 CD8 was down to 900.

So, we did more labs, which I have not gotten yet. Discussed meds. I have been thinking if anxiety can cause this result, then what would the flu do? If my numbers are fluctuating that much every month, what does that mean, in terms of health. I mean, I would normally do my labs, when I feel good. So, I get the results in the times I feel good. But, a good week each month, I have that high anxiety feeling, which makes me feel crappy. So, that makes me wonder whether certain times of the month, my numbers dip and my vl goes up. It does leave me wondering whether my status quo is really all that status quo. Or, whether fluctuations would be expected for someone not on meds.

Didn't mean to hijack the thread, but since there is a discussion going.... On the other hand, I may have to make a med decision soon, if these labs are the same or worse. This could be something real and not just an off lab, due to anxiety.

Ok I have an analogy.

Few years back I was sitting in the doctors office and he told me I needed to start taking high blood pressure medicine. It seemed my bp was getting high. I countered back to the doctor that it was white coat syndrome. That going to the doctor made me nervous and gave me anxiety which was causing my Bp to show high. Which was absolutely true.

My doctor looked at me, paused, and said in a rather commanding tone "so what?" He countered, lets jus say your 100%right and going to the doctor gives you anxiety which causes your bp to rise. If going to the doctor does that he said I'm sure there are a hundred other circumstances throughout the day that stress you out and cause anxiety also and if your blood pressure is rising here its also rising during those times as well and if your bl is rising its causing damage, regardless of the reason, its causing damage. Is that a reason to not treat something that is causing you damage?

I think we humans have a outstanding need to explain things away. Our viral load increases by a factor of 100 and we explain it away as "I had a cold sore" so it's ok. Or my labs were off but I had anxiety that day so, its ok because when I don't have anxiety my labs are better. That doesn't mean that its still not causing you damage in the long run, right?

HSV-1 infection is endemic within the human population. Many individuals carry the virus without any apparent disease. In contrast, others suffer from frequent virus reactivation and recurrent disease. One may assume that susceptibility to HSV-1 reactivation is linked to a partial deficient immunity.

In order to fight any Herpes virus reactivation , the system needs to suddenly expend the number of CD4 (helper) cells

This expansion is rapidly obtained by CD4 cell division where CD4 will clones themselves millions times to sustain the attack.

most of your CD4 are virus free, but some are virus infected.

if you have a rapid expansion of CD4 due a a disease or reactivation (or, interestingly due to vaccination) that increase affects HIV free CD4 in the same fashion it affects HIV infected CD4.

You may want to notice that on that day you CD4 count was the highest ever

At ca. 800 vs a baseline almost stable at ca. 670 that is a 20% increase...

Now, lets go to the decrease kinetics.

Since you system obviously controls the virus in a very enviable fashion, your virus free CD4s still enjoy a 'normal' half life of 6 months

your over numerous 20% virus free CD4 will die at a very slow rate...

On the other hand your HIV infected CD4 have most likely a half life of only one day. They will die and divide at at high rate

Since the VL is merely the measurement of RNA left behind as remains of DEAD CD4s, the rapid decay of that supernumerous spike in infected CD4 cells will result in a spike of VL

I hope this simplified explanation is graphic enough to understand why an Herpes virus reactivation leads to a spike in VL

It also reminds everyone that when monitoring your VL (if not under meds) or during the first 6 months since meds initiation, it is recommended to have the blood drawn BEFORE the flu vaccination, since the flu vaccination will induce a transient (usually small) spike in VL. and generate pointless worries.

I hope this explanation will help you feel better about the event

I can sympathize with the scare, but a transient should not derive you from the general understanding that , thus far you belong to the happy few who can somehow control the virus.

If I were in your shoes I would be very displeased with that single event, but, I would stay course and remain off meds...

That's an interesting read. I've gone through a fair few articles on it but you've given an easy explanation which backed up what I was thinking. Thanks for taking the time to write it. I figured the rise in CD4s was also a result of infection.

I feel much better now the results have confirmed what I was thinking, thanks.

On a side note my 'enviable' immune system has given me lifelong eczema which has, at times, ruined my quality of life and laid low my self esteem. It's all swings and roundabouts.

Question : how would your rate may prediction dated 2010 Nov 8 th, now that we have results as to Sept 2012 ?

Not too bad ... (IMHO)

So YES herpes viruses have an interplay with the VL !

Now, there is well enough evidence that CMV is much more 'nasty' in that respect than other Herpes viruses.

Back in the old days, when ALL patients where off-meds (because no meds available), those physicians that would proactively order a prophylactic treatment for CMV (ganciclovir and valganciclovir, if memory is correct) and prophylactic treatment for Herpes with acyclovir where getting better results in prolonging their patients lives than those who did not

Therefore, since you are not under meds, you may want to research a bit around this and talk your doctor into it.

This may help the other impairment of the immune system that your eczema seems to suggest.

BTW, I had a 20 years long fight with eczema/fungus that was clear with a 6 months treatment with LAMISIL

I had a rebound 2 years ago which was very limited in size but a concern because I know for a fact these guys are hard to get rid of. Doc did not want to prescribe Lamisil (since I am under meds) so I treated with topical Lamisilate.

More over, under the the nail, the fungus was shrinking when CD4/CD8 was > 1 and expending when < 1. After a continuous period of 6 months with CD4/CD8 ratio > 1, the bastard is gone. And I will be be very careful in the future

If you need anecdotal but interesting reading about Herpes virus and HIV, I recommend this

I have and will be taking this up with my doctor next time I see him. It could have a dramatic effect on my long yet health if a single outbreak can cause such a viral spike. I have read a few articles about acyclovir resistant hsv which doesn't sound like fun, this seems to be more common in HIV positive people on long term prophylactic treatment. It seems everything has a downside...

Maybe I could try it for a while and see what the effect is?

I would definitely suggest you try it. I had the same worries that you do regarding acyclovir resistance, but my doctor and several other knowledgeable people I talked to said it wasn't really an issue. In fact, I was told that taking it only when an outbreak was coming on (which is another way it's prescribed) was more likely to lead to resistance than taking it every day. My only regret was that I waited so long before starting it.

I've been on hiv meds now for just over a year and I'm playing with the idea of stopping the acyclovir, but I may wait another year. In the meantime, it's an easy, inexpensive drug to take and it saves me the bother and pain of having outbreaks. Also, I'm much less likely to pass my herpes on to anyone else while I'm on prophylactic acyclovir. It's win-win as far as I'm concerned.

PS Taking acyclovir as a prophylactic has another benefit in that if you ever feel an outbreak of shingles (herpes zoster) coming on, you'll have the med you need on hand to stop the shingles in its tracks.

This recently happened to me. I felt the tell-tale signs of shingles coming on in the same place I had it about eight years ago. I immediately started taking a higher dose of acyclovir (two 400mg tablet five times a day) and the shingles rash only got as far as making my skin a bit red before disappearing completely. I took the shingles dose for about five days and went back to the usual one 400mg tablet twice a day.

If I didn't have my acyclovir on hand, by the time I got a doctor appointment the rash would have been well-established and I'd be stuck with it. Once the rash is well established, you can still take acyclovir (within three days of the onset of symptoms) but it will only shorten the duration, at best. Being able to take it right away can circumvent the outbreak altogether.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts